Provider Demographics
NPI:1598967606
Name:ANGELO VU DO PA
Entity Type:Organization
Organization Name:ANGELO VU DO PA
Other - Org Name:THE INTERNAL MEDICINE CENTER OF FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-568-8700
Mailing Address - Street 1:12001 SOUTH HIGHWAY 35
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-568-8700
Mailing Address - Fax:817-568-8704
Practice Address - Street 1:12001 SOUTH HIGHWAY 35
Practice Address - Street 2:SUITE 200
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-568-8700
Practice Address - Fax:817-568-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188822401Medicaid
TX00X994Medicare PIN